Published online:05/02/2017
Published print:02/2017
ORIGINAL PAPER doi: 10.5455/medarh.2017.71.37-41
Med Arch. 2017 Feb; 71(1): 37-41 Received: DEC 05, 2016 | Accepted: JAN 15, 2017
© 2017 Merita Berisha, Naser Ramadani, Rina Hoxha, Sanije Gashi, Valbona Zhjeqi, Drita Zajmi, Ilir Begolli
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Knowledge, Attitudes and Practices of Mothers in Kosova About Complementary Feeding for Infant and Children 6-24 Months Merita Berisha1,2, Naser Ramadani1,2, Rina Hoxha1,2, Sanije Gashi1,2, Valbona Zhjeqi1,2, Drita Zajmi1,2, Ilir Begolli1,2 1 2
National Institute of Public Health of Kosova, Prishtina, Kosovo Medical Faculty, “Hasan Pristina University”, Prishtina, Kosova
Corresponding author: Associate Prof Naser Ramadani, MD, PhD, National Institute of Public Health of Kosova. Faculty of Medicine,“Hasan Pristina University”, Pristina, Kosova. Tel: +381 38 541-432. E-mail: [email protected]
ABSTRACT Aim: This cross sectional study assessed knowledge, attitudes and practices regarding complementary feeding among mothers with children between 6-24 months at the national level. Methods: The sample of 492 mothers with children between 6-24 months, with a confidence level of 95%, the acceptable margin of 5%, the expected prevalence of 50% knowledge and effect of 1.3, were interviewed from all regions, in all Kosovo. Data were analyzed using SPSS version 17.0 and presented using descriptive and inferential statistics such as Chi-square with significance level set at 5%. Results: Overall, 88.4% of respondents had good knowledge of complementary feeding, while only 38.4% of mothers had good practices regarding time for starting complementary feeding. We found association between maternal knowledge and level of education for complementary feeding. Conclusion: There is a need to further explore the factors responsible to improving practices for complementary feeding. Keywords: Complementary feeding, Knowledge and Practice, Kosova.
1. INTRODUCTION
Complementary feeding refers to the process of starting giving foods and liquids other than breast milk to the infants for their nutritional needs due to the insufficiency of the breast milk (1). According to the World Health Organization (WHO), the complementary feeding must possess the following three main characteristics: Timely: Giving foods to all infants should be started from 6 months onwards; Adequate: The complementary foods should be of a nutritional value that can satisfy the growth needs of the child; Appropriate: The foods selected for complementary foods must have variety, be of appropriate texture and in sufficient quantity (2). Inappropriate complementary feeding practices cause to some problems such as stunting, delay in the motor and mental development, neurolog-
ORIGINAL PAPER | Med Arch. 2017 Feb; 71(1): 37-41
ical and mental fatigue, frequent diarrhea, lack of micro-nutrients, and macro-nutrients or malnutrition (3). Data from the World Bank report shows that the health situation around birth and the first year of life is poor in Kosovo, as well as among the worst in Europe and the region (4). WHO recommends that infants start receiving complementary foods at 6 months of age in addition to breast milk, initially 2-3 times a day between 6-8 months, increasing to 3-4 times daily between 9-11 months and 12-24 months with additional nutritious snacks offered 1-2 times per day, as desired (5). It has been suggested that in addition to disease prevention strategies, complementary feeding interventions targeting this “critical window” are most efficient in reducing malnutrition and promoting adequate growth and development (6). Good nutrition is es-
37
Knowledge, Attitudes and Practices of Mothers in Kosova
sential for healthy development. Malnutrition, as a result of bad practice of nutrition and lack of micro-nutrients such as vitamin A, iron, iodine and zinc, will contribute to increased morbidity and mortality among young children (7). A twenty-five children (four per cent) under the age of 5 have stagnated medium or heavy growth or are too short for their age, reflecting malnutrition chronic as a result of not receiving the nutrition adequate for a long period and frequent or chronic diseases. This low percentage shows no apparent problems regarding stagnation in growth or underweight (8). In most developing countries has proven link between practice breastfeeding in the first month of life and neonatal mortality (in the first month of life) and the fact that breast-feeding plays an important role in reducing neonatal mortality (9). Adequate nutrition during infancy and early childhood is essential to ensure the growth, health, and development of children to their full potential. Poor nutrition increases the risk of illness, and is responsible, directly or indirectly, for one third of the estimated 9.5 million deaths that occurred in 2006 in children less than 5 years of age. Inappropriate nutrition can also lead to childhood obesity which is an increasing public health problem in many countries. There is evidence that adults who were malnourished in early childhood have impaired intellectual performance. The first two years of life provide a critical window of opportunity for ensuring children’s appropriate growth and development through optimal feeding. Feeding practice has a lot of implication for the nutritional status of the child. Mothers’ knowledge about nutritious meals for the children influences how the child is fed. In many developing countries infants and young children are most vulnerable to malnutrition because of lack of knowledge on how to feed a child (10). Several observational studies show that maternal knowledge of optimal child feeding practices like exclusive breastfeeding for six months, continued breastfeeding and the timely transition to adequate complementary food is basic to keep health of a child (WHO, 2010) (11).. A study by Hellen Keller International (2010) (12) in Baitadi District, Nepal showed that 28% and 42.1% of mothers had the perception that children of 6-12 months should not be fed on eggs and flesh meats, this translated to only 2.1% and 4.4% of their children being fed on eggs and flesh meats respectively. Scientific knowledge demonstrates that maternal knowledge on complementary feeding may positively influence practice or may lead to no change in feeding practices. Sethi et al., 2003 in their study in India, where nutritional education was given to mothers to improve awareness about infant feeding in the variety, quantity, quality and consistency of complementary feeding showed that, 86% complementary feeding practices were inadequate in quality, quantity, frequency and consistency (13). In a similar study in South India, mothers were counseled about the choice of appropriate complementary foods and feeding frequency. The intervention group had improved feeding practices such as avoiding feeding bottles and improved on dietary diversity and the types of complementary foods (14). Knowledge may not translate to practice, a study by
38
Subedi et al (15) on infant and young child feeding practices in Chepang communities in Nepal showed that, only 35% had knowledge about breastfeeding initiation within one hour, 62% had known about exact time for exclusive breastfeeding and 81% mothers had knowledge about appropriate time for introduction of complementary feeding and total time for 11 breastfeeding. Findings from study (16, 17) revealed that a high proportion of the respondents were knowledgeable on the introduction of complementary feeding at 6 months . Even it is recommended that infants start solid foods at 6 months, about one third of infants 6-8 months old, globally, are not yet eating solid foods. The situation is different among Regions, from about half of infants in South Asia to more than 80 per cent in Latin America and the Caribbean, but the indicator does not reflect how many infants started their first foods before the recommended age of 6 months (34).
2. AIM
The objective of the study is: Assessment of Knowledge, Attitudes, Practices (KAP) of mothers in Kosovo for supplementary food among infant and children 6-24 months.
3. MATERIAL AND METHODS
Study design: This descriptive, cross-sectional study was conducted during May-July 2013, and it assessed the mother’s knowledge and practice of complementary feeding from 28 locations cities, towns and villages across Kosovo. The sample of 492 mothers with infant between 6-24 months, with a confidence level of 95%, acceptable margin of 5%, the expected prevalence of knowledge 50% and effect of 1.3, were interviewed from all regions. Instrument for data collection: Study is based on interviews using the questionnaire as the instrument for data collection to elicit information from the study participants. The sections of the questionnaire were divided into: sociodemographic characteristics, knowledge on complementary feeding, attitudes and complementary feeding practice of mothers with infant between 6-24 months. Data analysis: The data collected was analyzed using SPSS version 17.0 and presented using descriptive and inferential statistics such as Chi-square test with the level of significance set at 5%. Ethics: The study was conducted from the National Institute of Public Health of Kosova and approved from the Board of the National Institute of Public Health of Kosova.
4. RESULTS 4.1. Knowledge
Mother’s knowledge shows significant distinction according to higher level of education regarding perceptions that complementary feeding is the act of giving foods and liquids other than breast milk to the infants (96%), complementary food should be given to the infants after 6 months (61.9% both high school and university) and food supplementary vitamins should always be ORIGINAL PAPER | Med Arch. 2017 Feb; 71(1): 37-41
Modality
Primary school N=138
Total N=492
High University school / bachelor N=270 N=84
P-value
Published print:02/2017
ORIGINAL PAPER doi: 10.5455/medarh.2017.71.37-41
Med Arch. 2017 Feb; 71(1): 37-41 Received: DEC 05, 2016 | Accepted: JAN 15, 2017
© 2017 Merita Berisha, Naser Ramadani, Rina Hoxha, Sanije Gashi, Valbona Zhjeqi, Drita Zajmi, Ilir Begolli
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Knowledge, Attitudes and Practices of Mothers in Kosova About Complementary Feeding for Infant and Children 6-24 Months Merita Berisha1,2, Naser Ramadani1,2, Rina Hoxha1,2, Sanije Gashi1,2, Valbona Zhjeqi1,2, Drita Zajmi1,2, Ilir Begolli1,2 1 2
National Institute of Public Health of Kosova, Prishtina, Kosovo Medical Faculty, “Hasan Pristina University”, Prishtina, Kosova
Corresponding author: Associate Prof Naser Ramadani, MD, PhD, National Institute of Public Health of Kosova. Faculty of Medicine,“Hasan Pristina University”, Pristina, Kosova. Tel: +381 38 541-432. E-mail: [email protected]
ABSTRACT Aim: This cross sectional study assessed knowledge, attitudes and practices regarding complementary feeding among mothers with children between 6-24 months at the national level. Methods: The sample of 492 mothers with children between 6-24 months, with a confidence level of 95%, the acceptable margin of 5%, the expected prevalence of 50% knowledge and effect of 1.3, were interviewed from all regions, in all Kosovo. Data were analyzed using SPSS version 17.0 and presented using descriptive and inferential statistics such as Chi-square with significance level set at 5%. Results: Overall, 88.4% of respondents had good knowledge of complementary feeding, while only 38.4% of mothers had good practices regarding time for starting complementary feeding. We found association between maternal knowledge and level of education for complementary feeding. Conclusion: There is a need to further explore the factors responsible to improving practices for complementary feeding. Keywords: Complementary feeding, Knowledge and Practice, Kosova.
1. INTRODUCTION
Complementary feeding refers to the process of starting giving foods and liquids other than breast milk to the infants for their nutritional needs due to the insufficiency of the breast milk (1). According to the World Health Organization (WHO), the complementary feeding must possess the following three main characteristics: Timely: Giving foods to all infants should be started from 6 months onwards; Adequate: The complementary foods should be of a nutritional value that can satisfy the growth needs of the child; Appropriate: The foods selected for complementary foods must have variety, be of appropriate texture and in sufficient quantity (2). Inappropriate complementary feeding practices cause to some problems such as stunting, delay in the motor and mental development, neurolog-
ORIGINAL PAPER | Med Arch. 2017 Feb; 71(1): 37-41
ical and mental fatigue, frequent diarrhea, lack of micro-nutrients, and macro-nutrients or malnutrition (3). Data from the World Bank report shows that the health situation around birth and the first year of life is poor in Kosovo, as well as among the worst in Europe and the region (4). WHO recommends that infants start receiving complementary foods at 6 months of age in addition to breast milk, initially 2-3 times a day between 6-8 months, increasing to 3-4 times daily between 9-11 months and 12-24 months with additional nutritious snacks offered 1-2 times per day, as desired (5). It has been suggested that in addition to disease prevention strategies, complementary feeding interventions targeting this “critical window” are most efficient in reducing malnutrition and promoting adequate growth and development (6). Good nutrition is es-
37
Knowledge, Attitudes and Practices of Mothers in Kosova
sential for healthy development. Malnutrition, as a result of bad practice of nutrition and lack of micro-nutrients such as vitamin A, iron, iodine and zinc, will contribute to increased morbidity and mortality among young children (7). A twenty-five children (four per cent) under the age of 5 have stagnated medium or heavy growth or are too short for their age, reflecting malnutrition chronic as a result of not receiving the nutrition adequate for a long period and frequent or chronic diseases. This low percentage shows no apparent problems regarding stagnation in growth or underweight (8). In most developing countries has proven link between practice breastfeeding in the first month of life and neonatal mortality (in the first month of life) and the fact that breast-feeding plays an important role in reducing neonatal mortality (9). Adequate nutrition during infancy and early childhood is essential to ensure the growth, health, and development of children to their full potential. Poor nutrition increases the risk of illness, and is responsible, directly or indirectly, for one third of the estimated 9.5 million deaths that occurred in 2006 in children less than 5 years of age. Inappropriate nutrition can also lead to childhood obesity which is an increasing public health problem in many countries. There is evidence that adults who were malnourished in early childhood have impaired intellectual performance. The first two years of life provide a critical window of opportunity for ensuring children’s appropriate growth and development through optimal feeding. Feeding practice has a lot of implication for the nutritional status of the child. Mothers’ knowledge about nutritious meals for the children influences how the child is fed. In many developing countries infants and young children are most vulnerable to malnutrition because of lack of knowledge on how to feed a child (10). Several observational studies show that maternal knowledge of optimal child feeding practices like exclusive breastfeeding for six months, continued breastfeeding and the timely transition to adequate complementary food is basic to keep health of a child (WHO, 2010) (11).. A study by Hellen Keller International (2010) (12) in Baitadi District, Nepal showed that 28% and 42.1% of mothers had the perception that children of 6-12 months should not be fed on eggs and flesh meats, this translated to only 2.1% and 4.4% of their children being fed on eggs and flesh meats respectively. Scientific knowledge demonstrates that maternal knowledge on complementary feeding may positively influence practice or may lead to no change in feeding practices. Sethi et al., 2003 in their study in India, where nutritional education was given to mothers to improve awareness about infant feeding in the variety, quantity, quality and consistency of complementary feeding showed that, 86% complementary feeding practices were inadequate in quality, quantity, frequency and consistency (13). In a similar study in South India, mothers were counseled about the choice of appropriate complementary foods and feeding frequency. The intervention group had improved feeding practices such as avoiding feeding bottles and improved on dietary diversity and the types of complementary foods (14). Knowledge may not translate to practice, a study by
38
Subedi et al (15) on infant and young child feeding practices in Chepang communities in Nepal showed that, only 35% had knowledge about breastfeeding initiation within one hour, 62% had known about exact time for exclusive breastfeeding and 81% mothers had knowledge about appropriate time for introduction of complementary feeding and total time for 11 breastfeeding. Findings from study (16, 17) revealed that a high proportion of the respondents were knowledgeable on the introduction of complementary feeding at 6 months . Even it is recommended that infants start solid foods at 6 months, about one third of infants 6-8 months old, globally, are not yet eating solid foods. The situation is different among Regions, from about half of infants in South Asia to more than 80 per cent in Latin America and the Caribbean, but the indicator does not reflect how many infants started their first foods before the recommended age of 6 months (34).
2. AIM
The objective of the study is: Assessment of Knowledge, Attitudes, Practices (KAP) of mothers in Kosovo for supplementary food among infant and children 6-24 months.
3. MATERIAL AND METHODS
Study design: This descriptive, cross-sectional study was conducted during May-July 2013, and it assessed the mother’s knowledge and practice of complementary feeding from 28 locations cities, towns and villages across Kosovo. The sample of 492 mothers with infant between 6-24 months, with a confidence level of 95%, acceptable margin of 5%, the expected prevalence of knowledge 50% and effect of 1.3, were interviewed from all regions. Instrument for data collection: Study is based on interviews using the questionnaire as the instrument for data collection to elicit information from the study participants. The sections of the questionnaire were divided into: sociodemographic characteristics, knowledge on complementary feeding, attitudes and complementary feeding practice of mothers with infant between 6-24 months. Data analysis: The data collected was analyzed using SPSS version 17.0 and presented using descriptive and inferential statistics such as Chi-square test with the level of significance set at 5%. Ethics: The study was conducted from the National Institute of Public Health of Kosova and approved from the Board of the National Institute of Public Health of Kosova.
4. RESULTS 4.1. Knowledge
Mother’s knowledge shows significant distinction according to higher level of education regarding perceptions that complementary feeding is the act of giving foods and liquids other than breast milk to the infants (96%), complementary food should be given to the infants after 6 months (61.9% both high school and university) and food supplementary vitamins should always be ORIGINAL PAPER | Med Arch. 2017 Feb; 71(1): 37-41
Modality
Primary school N=138
Total N=492
High University school / bachelor N=270 N=84
P-value
